title: EBV-associated diffuse large B-cell lymphoma in a psoriatic treated with methotrexate.
abstract: Methotrexate-associated lymphoproliferative disorder (MTX-LPD) is a lymphoid proliferation or lymphoma in a patient immunosuppressed with MTX, which is usually administered for treating autoimmune diseases. The majority of MTX-LPD cases develop in patients with rheumatoid arthritis and occasionally with psoriasis who had been treated with MTX. Here, we report on a 50-year-old Taiwanese male with severe psoriasis, who received high doses of MTX. The patient developed EBV-positive MTX-LPD at nodal and extranodal sites. The diffuse and polymorphic lymphoid infiltrate consisted predominantly of immunoblasts and plasmablasts expressing B-cell markers, CD138, Epstein-Barr virus (EBV)-LMP1, and EBNA2, and these were monotypic for kappa light chain. The tumor cells were also positive for EBV by in situ hybridization. These findings indicated a type III latency infection of EBV. The patient died of progressive disease after 19 months. A review of the previously reported cases shows that MTX-LPD, in association with psoriasis, occurs in middle-aged males. The tumors are diffuse large B-cell lymphomas with immunoblastic morphology, and frequently show plasmacytic differentiation.
authors.affiliation: Department of Hemato-Oncology, St. Martin de Porres Hospital, Chia-Yi, Taiwan.
authors.forename: Shih-Chuan
authors.initials: SC
authors.lastname: Hsiao
authors.forename: Ryo
authors.initials: R
authors.lastname: Ichinohasama
authors.forename: Shu-Hui
authors.initials: SH
authors.lastname: Lin
authors.forename: Yung-Liang
authors.initials: YL
authors.lastname: Liao
authors.forename: Sheng-Tsung
authors.initials: ST
authors.lastname: Chang
authors.forename: Chi-Yi
authors.initials: CY
authors.lastname: Cho
authors.forename: Shih-Sung
authors.initials: SS
authors.lastname: Chuang
mesh_terms: D003879:Dermatologic Agents / Q000009:adverse effects*; D018450:Disease Progression; D020031:Epstein-Barr Virus Infections / Q000139:chemically induced* / Q000150:complications / Q000188:drug therapy / Q000235:genetics / Q000473:pathology; D017809:Fatal Outcome; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D007150:Immunohistochemistry; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D017404:In Situ Hybridization, Fluorescence; D016403:Lymphoma, Large B-Cell, Diffuse / Q000139:chemically induced* / Q000188:drug therapy / Q000235:genetics / Q000473:pathology / Q000821:virology*; D008297:Male; D008727:Methotrexate / Q000009:adverse effects*; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011565:Psoriasis / Q000188:drug therapy*; D012720:Severity of Illness Index
chemical_list: D003879:Dermatologic Agents; D007166:Immunosuppressive Agents; D008727:Methotrexate